|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
IP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Adventist Health Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Central Health Plan Commercial |
$50.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$47.05
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
OP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Adventist Health Commercial |
$12.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.84
|
| Rate for Payer: Blue Shield of California Commercial |
$38.33
|
| Rate for Payer: Blue Shield of California EPN |
$25.03
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Central Health Plan Commercial |
$50.18
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.46
|
| Rate for Payer: InnovAge PACE Commercial |
$31.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.91
|
| Rate for Payer: Multiplan Commercial |
$47.05
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
| Rate for Payer: Riverside University Health System MISP |
$25.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other HMO |
$31.36
|
| Rate for Payer: United Healthcare HMO Rider |
$31.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
IP
|
$633.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.71 |
| Max. Negotiated Rate |
$570.20 |
| Rate for Payer: Adventist Health Commercial |
$126.71
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Central Health Plan Commercial |
$506.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.42
|
| Rate for Payer: EPIC Health Plan Senior |
$253.42
|
| Rate for Payer: Galaxy Health WC |
$538.53
|
| Rate for Payer: Global Benefits Group Commercial |
$380.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.71
|
| Rate for Payer: Multiplan Commercial |
$475.17
|
| Rate for Payer: Networks By Design Commercial |
$411.81
|
| Rate for Payer: Prime Health Services Commercial |
$538.53
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
OP
|
$633.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$570.20 |
| Rate for Payer: Adventist Health Commercial |
$126.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$384.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.09
|
| Rate for Payer: Blue Shield of California Commercial |
$387.11
|
| Rate for Payer: Blue Shield of California EPN |
$252.79
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Central Health Plan Commercial |
$506.85
|
| Rate for Payer: Cigna of CA HMO |
$405.48
|
| Rate for Payer: Cigna of CA PPO |
$468.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.42
|
| Rate for Payer: EPIC Health Plan Senior |
$253.42
|
| Rate for Payer: Galaxy Health WC |
$538.53
|
| Rate for Payer: Global Benefits Group Commercial |
$380.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$316.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.49
|
| Rate for Payer: Multiplan Commercial |
$475.17
|
| Rate for Payer: Networks By Design Commercial |
$411.81
|
| Rate for Payer: Prime Health Services Commercial |
$538.53
|
| Rate for Payer: Riverside University Health System MISP |
$253.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.78
|
| Rate for Payer: United Healthcare All Other HMO |
$316.78
|
| Rate for Payer: United Healthcare HMO Rider |
$316.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$316.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.53
|
| Rate for Payer: Vantage Medical Group Senior |
$538.53
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Central Health Plan Commercial |
$33.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.56
|
| Rate for Payer: Blue Shield of California Commercial |
$25.55
|
| Rate for Payer: Blue Shield of California EPN |
$16.69
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Central Health Plan Commercial |
$33.46
|
| Rate for Payer: Cigna of CA HMO |
$26.76
|
| Rate for Payer: Cigna of CA PPO |
$30.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.64
|
| Rate for Payer: InnovAge PACE Commercial |
$20.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.27
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
| Rate for Payer: Riverside University Health System MISP |
$16.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.55
|
| Rate for Payer: Vantage Medical Group Senior |
$35.55
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
OP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.58
|
| Rate for Payer: Blue Shield of California Commercial |
$4.76
|
| Rate for Payer: Blue Shield of California EPN |
$3.11
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
| Rate for Payer: Riverside University Health System MISP |
$3.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
IP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
IP
|
$156.03
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$140.43 |
| Rate for Payer: Adventist Health Commercial |
$31.21
|
| Rate for Payer: Cash Price |
$70.21
|
| Rate for Payer: Central Health Plan Commercial |
$124.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.41
|
| Rate for Payer: EPIC Health Plan Senior |
$62.41
|
| Rate for Payer: Galaxy Health WC |
$132.63
|
| Rate for Payer: Global Benefits Group Commercial |
$93.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.21
|
| Rate for Payer: Multiplan Commercial |
$117.02
|
| Rate for Payer: Networks By Design Commercial |
$101.42
|
| Rate for Payer: Prime Health Services Commercial |
$132.63
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
OP
|
$156.03
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$140.43 |
| Rate for Payer: Adventist Health Commercial |
$31.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.64
|
| Rate for Payer: Blue Shield of California Commercial |
$95.33
|
| Rate for Payer: Blue Shield of California EPN |
$62.26
|
| Rate for Payer: Cash Price |
$70.21
|
| Rate for Payer: Central Health Plan Commercial |
$124.82
|
| Rate for Payer: Cigna of CA HMO |
$99.86
|
| Rate for Payer: Cigna of CA PPO |
$115.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.41
|
| Rate for Payer: EPIC Health Plan Senior |
$62.41
|
| Rate for Payer: Galaxy Health WC |
$132.63
|
| Rate for Payer: Global Benefits Group Commercial |
$93.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.43
|
| Rate for Payer: InnovAge PACE Commercial |
$78.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.22
|
| Rate for Payer: Multiplan Commercial |
$117.02
|
| Rate for Payer: Networks By Design Commercial |
$101.42
|
| Rate for Payer: Prime Health Services Commercial |
$132.63
|
| Rate for Payer: Riverside University Health System MISP |
$62.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.02
|
| Rate for Payer: United Healthcare All Other HMO |
$78.02
|
| Rate for Payer: United Healthcare HMO Rider |
$78.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.63
|
| Rate for Payer: Vantage Medical Group Senior |
$132.63
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
IP
|
$54.53
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Adventist Health Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Central Health Plan Commercial |
$43.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: EPIC Health Plan Senior |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$46.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$40.90
|
| Rate for Payer: Networks By Design Commercial |
$35.44
|
| Rate for Payer: Prime Health Services Commercial |
$46.35
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
OP
|
$54.53
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Adventist Health Commercial |
$10.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.03
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$21.76
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Central Health Plan Commercial |
$43.62
|
| Rate for Payer: Cigna of CA HMO |
$34.90
|
| Rate for Payer: Cigna of CA PPO |
$40.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: EPIC Health Plan Senior |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$46.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.08
|
| Rate for Payer: InnovAge PACE Commercial |
$27.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.17
|
| Rate for Payer: Multiplan Commercial |
$40.90
|
| Rate for Payer: Networks By Design Commercial |
$35.44
|
| Rate for Payer: Prime Health Services Commercial |
$46.35
|
| Rate for Payer: Riverside University Health System MISP |
$21.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.27
|
| Rate for Payer: United Healthcare All Other HMO |
$27.27
|
| Rate for Payer: United Healthcare HMO Rider |
$27.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.35
|
| Rate for Payer: Vantage Medical Group Senior |
$46.35
|
|
|
HC DRSNG WOUND DURAFIBER AG 4X4
|
Facility
|
OP
|
$61.66
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.21
|
| Rate for Payer: Blue Shield of California Commercial |
$37.67
|
| Rate for Payer: Blue Shield of California EPN |
$24.60
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Central Health Plan Commercial |
$49.33
|
| Rate for Payer: Cigna of CA HMO |
$39.46
|
| Rate for Payer: Cigna of CA PPO |
$45.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.49
|
| Rate for Payer: InnovAge PACE Commercial |
$30.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$46.24
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
| Rate for Payer: Riverside University Health System MISP |
$24.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.83
|
| Rate for Payer: United Healthcare All Other HMO |
$30.83
|
| Rate for Payer: United Healthcare HMO Rider |
$30.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.41
|
| Rate for Payer: Vantage Medical Group Senior |
$52.41
|
|
|
HC DRSNG WOUND DURAFIBER AG 4X4
|
Facility
|
IP
|
$61.66
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Central Health Plan Commercial |
$49.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.33
|
| Rate for Payer: Multiplan Commercial |
$46.24
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
IP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$56.09
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
OP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.92
|
| Rate for Payer: Blue Shield of California Commercial |
$45.69
|
| Rate for Payer: Blue Shield of California EPN |
$29.84
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: Cigna of CA HMO |
$47.86
|
| Rate for Payer: Cigna of CA PPO |
$55.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: InnovAge PACE Commercial |
$37.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.35
|
| Rate for Payer: Multiplan Commercial |
$56.09
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
| Rate for Payer: Riverside University Health System MISP |
$29.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.39
|
| Rate for Payer: United Healthcare All Other HMO |
$37.39
|
| Rate for Payer: United Healthcare HMO Rider |
$37.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.56
|
| Rate for Payer: Vantage Medical Group Senior |
$63.56
|
|
|
HC DRSNG WOUND GAUZE ADH 4X14"
|
Facility
|
OP
|
$6.97
|
|
| Hospital Charge Code |
901698919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4.26
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.58
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.27
|
| Rate for Payer: InnovAge PACE Commercial |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Riverside University Health System MISP |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
HC DRSNG WOUND GAUZE ADH 4X14"
|
Facility
|
IP
|
$6.97
|
|
| Hospital Charge Code |
901698919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
OP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$304.61 |
| Rate for Payer: Adventist Health Commercial |
$67.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$205.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.77
|
| Rate for Payer: Blue Shield of California Commercial |
$206.79
|
| Rate for Payer: Blue Shield of California EPN |
$135.04
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Central Health Plan Commercial |
$270.76
|
| Rate for Payer: Cigna of CA HMO |
$216.61
|
| Rate for Payer: Cigna of CA PPO |
$250.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$287.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$287.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$287.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Senior |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$304.61
|
| Rate for Payer: InnovAge PACE Commercial |
$169.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$236.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$236.91
|
| Rate for Payer: Multiplan Commercial |
$253.84
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
| Rate for Payer: Riverside University Health System MISP |
$135.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.22
|
| Rate for Payer: United Healthcare All Other HMO |
$169.22
|
| Rate for Payer: United Healthcare HMO Rider |
$169.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$287.68
|
| Rate for Payer: Vantage Medical Group Senior |
$287.68
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
IP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$304.61 |
| Rate for Payer: Adventist Health Commercial |
$67.69
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Central Health Plan Commercial |
$270.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Senior |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$304.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.69
|
| Rate for Payer: Multiplan Commercial |
$253.84
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
IP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$189.76 |
| Rate for Payer: Adventist Health Commercial |
$42.17
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Central Health Plan Commercial |
$168.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Senior |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.17
|
| Rate for Payer: Multiplan Commercial |
$158.13
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
OP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$189.76 |
| Rate for Payer: Adventist Health Commercial |
$42.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.83
|
| Rate for Payer: Blue Shield of California Commercial |
$128.82
|
| Rate for Payer: Blue Shield of California EPN |
$84.13
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Central Health Plan Commercial |
$168.67
|
| Rate for Payer: Cigna of CA HMO |
$134.94
|
| Rate for Payer: Cigna of CA PPO |
$156.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Senior |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.76
|
| Rate for Payer: InnovAge PACE Commercial |
$105.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.59
|
| Rate for Payer: Multiplan Commercial |
$158.13
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
| Rate for Payer: Riverside University Health System MISP |
$84.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.42
|
| Rate for Payer: United Healthcare All Other HMO |
$105.42
|
| Rate for Payer: United Healthcare HMO Rider |
$105.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.21
|
| Rate for Payer: Vantage Medical Group Senior |
$179.21
|
|
|
HC DRSNG WOUND MEPLIX LITE 4X4
|
Facility
|
OP
|
$23.69
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901692023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$21.32 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.91
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$9.45
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Central Health Plan Commercial |
$18.95
|
| Rate for Payer: Cigna of CA HMO |
$15.16
|
| Rate for Payer: Cigna of CA PPO |
$17.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.32
|
| Rate for Payer: InnovAge PACE Commercial |
$11.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.58
|
| Rate for Payer: Multiplan Commercial |
$17.77
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
| Rate for Payer: Riverside University Health System MISP |
$9.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.85
|
| Rate for Payer: United Healthcare All Other HMO |
$11.85
|
| Rate for Payer: United Healthcare HMO Rider |
$11.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.14
|
| Rate for Payer: Vantage Medical Group Senior |
$20.14
|
|
|
HC DRSNG WOUND MEPLIX LITE 4X4
|
Facility
|
IP
|
$23.69
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901692023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$21.32 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Central Health Plan Commercial |
$18.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Multiplan Commercial |
$17.77
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
OP
|
$3.12
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Central Health Plan Commercial |
$2.50
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: InnovAge PACE Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Riverside University Health System MISP |
$1.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
